Podcast

All Articles in the Category ‘Podcast’

When Is It ADHD In A Child?

I talked with Erin Schoenfelder, PhD,a specialist in ADHD and Director of Behavioral Treatment at the PEARL Clinic (Program to Enhance Attention, Regulation & Learning) here at Seattle Children’s Hospital, about ways to recognize ADHD in children and teens. The previous post we shared included the acknowledgment that it may be harder to parent a child with ADHD and provided reasons for it along with 5 tips to help parents and families. In the podcast above, Dr. Schoenfelder helps parents, teachers, and pediatricians understand what ADHD is and identifies ways to support, diagnose, and evaluate children with whom parents and teacher hold concern. First and foremost make sure you understand how a child sleeps before doing any further work-ups! Sleep challenges can be a big mimicker of ADHD as deprivation causes inattention and distractibility.

What is ADHD?

  • Developmentally atypical symptoms of inattention and/or hyperactivity/impulsivity.
  • Developmental disorder that persists over time and years and is consistent across settings (i.e. children have challenges at school, at home, during sports activities, at a synagogue or church).

Signs, Symptoms, Red Flags

  • Problems in multiple settings completing work, getting along with others, following directions, and succeeding
  • Teacher noticing the child is standing out from others
  • Child an outlier in a group – soccer practice, birthday parties, home
  • Risky behavior, getting injured due to impulsivity
  • Falling behind in learning due to off-task behavior

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3 Reasons And 5 Tips For Parenting A Child With ADHD

Turns out that in clinical practice I’ve learned that it’s okay to acknowledge that some children are simply harder to parent than others. From what I can tell it’s really true. Often those parents struggling with children with behavioral challenges blame themselves more than is necessary. Sometimes rationale for why it’s harder helps.

There are all sorts of reasons for increased challenge. Chronic or challenging underlying illness, mental health struggles, and/or behavior challenges are a few of the reasons that some parents have a much harder job. I talked with Erin Schoenfelder, Ph.D. a specialist in ADHD and Director of Behavioral Treatment at the PEARL Clinic (Program to Enhance Attention, Regulation & Learning) here at Seattle Children’s Hospital about how parents often NEED a different parenting strategy if their child has ADHD. She outlines it beautifully in the podcast. These 3 reasons and these 5 strategies Dr. Schoenfelder shares can help families support children with the unique challenges that come along with ADHD.

Why do children with ADHD need different parenting strategies?

Normal good parenting strategies (sticker charts, send to room, natural consequences) don’t seem to work for kids with ADHD. Parents need additional strategies. When children with ADHD fail to thrive in typical structures for reinforcement, it doesn’t mean parents are failing. Parenting a child with ADHD can at times be harder than parenting a child without attention challenges.

1. Children may lack internal “self regulation”

  • Kids not regulating their own engines to stay on track. So children with ADHD may be very susceptible to external environments, including distractions, inconsistencies.
  • Therefore, behavior is inconsistent. Kids aren’t able to do what they know how to do.

2. Limited window on time for discipline

  • “Now” versus “Not Now.” Make sure you provide immediate feedback for children with ADHD. If you wait, it may lose relevance or even be lost in the memory bank.
  • Children with ADHD may have a tendency to have their window get “flooded” easily, and they cannot shift forward to predict what will happen next, or backwards to recall what has/hasn’t worked in the past.
  • Children don’t connect behavior and consequence the same way as children without ADHD.

3. Children with ADHD may have different processing of rewards

  • Dopamine is processed differently in the brain of children with ADHD. Therefore when they get the chemical kick of reward, they may experience it differently.
  • Everyday things feel less rewarding and interesting than they are for other kids.
  • Other things (screens) may feel SUPER rewarding…

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Playing Multiple Sports Is Better For Most Children

New data out (that I happen to LOVE) seems to go against many parental instincts, including a few of my own. I think plenty of parents have been led to believe in the last few decades that specialization and mastery in a single sport early in life is GOOD for their children. Some of that instinct rises from our guts in the mis-appointed “10,000 hours rule.” The idea that once our children do something for 10,000 hours they will be an expert. The 10,000 hour rule (brought to masses in part via Malcolm Gladwell) suggests that with dedication and time (10,000 hours) a person will develop mastery over a sport or skill. A recent American Academy of Pediatrics clinical report states, “it has often been misquoted that to succeed, an athlete needs to have 10,000 hours of practice/competition over 10 years. The media have incorrectly extrapolated Ericsson and co-workers’ studies of chess players to a formula for sports success. Many examples exist of successful athletes who have <10,000 hours and others who have not succeeded despite having >10,000 hours of practice/competition.”

Children in sports have changed over the last 40 years.

There is increased pressure to participate at a high level, to specialize in 1 sport early, and to play year-round, often on multiple teams. This increased emphasis on sports specialization has led to an increase in overuse injuries, overtraining, and burnout. ~Dr. Joel S. Brenner

And it’s just not true that grunt hours in a single sport will make champions of all of our children. Worse — focusing early and often on one single sport may lead to overuse injuries, burnout, isolation, and a less likely shot at succeeding at and loving sports for a lifetime.

overuse-injuries-1

I think in the time of the tech boom we can also be led astray by the “Zuckerberg effect”  — the idea that we can only really change the world by focusing on a single thing and becoming a global master in doing so.

Reality is, those children who specialize in a single sport early are at higher risk for overuse injuries, burnout, quitting sports altogether and even isolation and loneliness. Successful, even elite athletes, are more likely to develop when our children don’t specialize in a single sport until late puberty, around age 15 or 16 years.  Read full post »

No More Antibacterial Soap At Home or School

It’s a clear no-go on those “antibacterial” soaps you see on people’s counters and sometimes in our schools. They are soon to vanish from stores. No good evidence the (typically liquid) soaps actually protect our family from bacterial infections better than washing with regular soap and water and there are some concerns the ingredients used to make the soap may pose risk. Because of this, the Food and Drug Administration (FDA) recently announced a ban on chemicals/pesticides used in antibacterial soaps due to safety concerns, including two of the most commonly used ingredients: triclosan and triclocarban. Some of these antibacterial soaps will still be used in hospitals.

Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water.” ~ Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation & Research

Some history: Back in 2013 the FDA asked companies that produce antibacterial soaps to prove that their products were more effective than basic soap and water. Turns out, they couldn’t (or didn’t) provide data to show that these products were safe for long-term use nor that they are more effective. We know anytime we add antibiotics into our environment. water, food or agriculture, they kill bacteria off so that bugs that are less treatable with medicines have an easier time surviving. The end result are so-called, “superbugs” or bacteria in our environment and thankfully, rarely in our bodies, that are difficult or impossible to treat. That’s a LOSE-LOSE for humans (and animals). Hence the new ban on these soaps. Companies now must comply with removing the chemicals within 1 year’s time, or take the products off the market. There are 3 chemicals used in some soaps still allowed (not included in the 19 ingredients listed in the FDA ban) that rarely may still be found.

Why We Don’t Want To Use “Antibiotic” Soap

Some bacteria are good (the ones that live in our guts and the ones that live on our skin, for example) and contribute to our microbiome. We want to preserve those as these bacteria protect us, help us break down food, and even support vitamin production. There is also some data that every course of antibiotics we ever take changes this microbiome and may have lasting and long-term effects including susceptibility to chronic disease.

So as part of our wellness relies on these “good” bacteria, part of human wellness also relies on effective antibiotics against the bad ones (for serious infections, surgery, when an immune system is compromised). Clearly, we only want to use antibiotics when necessary; if we overuse them we create environments where resistant bacteria thrive. Once that happens, we won’t be able to cure infections they cause. Read full post »

Reducing Back To School Stress In 12 Minutes

I find the back-to-school time period to be a little bit stressful (hellowwww, understatement) and perhaps even anxiety inducing. Even good transitions rack up stress. As we brace for the holiday weekend and expect the onslaught of school in earnest while September unfolds, I suggest we can decrease the stress with a bit of info. Here’s my 12-minute podcast to support you as you send your kids back to school and set them up for an awesome start. We’re all hoping for a healthy, safe fall. Take a listen…it won’t take long and you may find yourself a little more relaxed and ready for the chaos. Immunizations, sleep, anxiety and tips for transitions!

Tips For Getting Sleep Schedules Ready For School:

  • Timing: Shift slowly and get started now. If bedtime has migrated to 10pm, for example, and you’re hoping to have your kids sleeping by 8pm for school, start now. Move bedtime forward about 30 minutes every 3 to 4 days.
  • Screens (this isn’t new, I know): Screens, using them and exposing ourselves to the light they emit, impairs our natural sleep hormone melatonin from rising and helping our brain drift off to sleep. Have all screens, tablets, phones, and laptops transition back to sleeping in the kitchen (not at the bedside). In minimum, turn off screens at least 1 hour before desired bedtime!
  • Sleep As Health: getting sufficient sleep contributes to improved attention, safer driving, less health risks, and a more steady mood. We’re nicer when we sleep! It also contributes to how we think on life and even how we remember events; when we don’t sleep we tend to remember things in more somber light. Getting enough sleep supports a healthier life and I would suggest an even happier one. Quick reminder: school-aged children need 9 to 11 hours of sleep and teens need 8 1/2 to 9 1/2 hours. Really!

 

6 Ways To Help An Anxious Child

No question it’s tough to keep our cool when our children are unraveling. It’s especially a challenge when our children are rattled and over-run with anxiety. I partner with parents on a weekly basis who feel their children are anxious. All of us want support in knowing just what TO DO in helping our children thrive while also not letting them suffer.

I partnered with Dr. Kathy Melman on the podcast to review tips and strategies for parenting when children are anxious or when our children suffer from anxiety. Dr. Melman is wonderfully steady and clear in knowing what we can do when we find ourselves amid a sea of anxiety. Dr. Melman explains how to improve the environment for our children, what we can do for ourselves as parents to protect our children, and how to help our children not only cope but thrive in the face of anxiety, disruption, fear, and challenge. Listen in and read her 6 tips below. Number four is a BIGGIE…

6 ways to Help Your Anxious Child:

  1. Modeling Matters: If a parent struggles with anxiety—get evidence based cognitive behavioral therapy (CBT) treatment with an adult anxiety specialist. Caring for your own anxiety will limit how your child models undesired behaviors.
  2. Intervene early and effectively! If your child shows signs of anxiety that is causing distress and/or interfering with functioning, seek CBT treatment with a child anxiety specialist. Don’t wait years for help because untreated anxiety can lead to problems including possible school refusal, lack of friends and opportunities to develop social skills, limited development of independence, healthy sleep patterns, lack of involvement in activities outside of the home, substance use and depression as one’s life shrinks with loneliness, low self esteem (“I can’t handle this”) and lack of building mastery. Anxious children often don’t get the help they need and when they do, they have often already suffered for years, other problems have developed, and they often don’t get the most effective, evidence based behavioral treatment.
  3. Acceptance and Empathy: Accept if your child is “wired together” to have more anxiety and be empathic, rather than invalidating, of their experience. Taking the moment to accept their feelings (even when they seem outlandish!) will allow you to both acknowledge and then support your child more effectively.
  4. Don’t Permit Avoidance: It is really hard to see your child suffer and parents often, meaning well, allow their child to escape and avoid anxiety provoking situations. As a parent, it is important to learn to tolerate this distress, remain calm and know that permitting escape and avoidance and providing excessive reassurance only strengthens anxiety, reinforces your child’s thoughts that the world is a scary place and the belief that they aren’t capable of coping effectively. This is an important dance parents often do with their anxious children and it is critical to change this pattern.
  5. Reward Brave Behavior: Instead of paying attention to anxious behavior, reward use of anxiety management skills (recognizing when anxious, which situations trigger anxiety, what happens in your body, what are your thoughts, calming your body, challenging unrealistic, catastrophic thinking with checking the facts to develop more realistic thinking along with coping and calming thoughts, and approach feared situations in a gradual, manageable, step by step fashion). We are asking our children to do what terrifies them so provide them with empathy, support, skills and coaching so they overcome anxiety by facing their fears and learning that they can, in fact, do this, nothing terrible will happen, and they can live a full life that is not limited by anxiety. Rewarding use of skills and facing fears (known as exposure) helps your child do what is challenging. Exposure is the most important ingredient in effective treatment of anxiety.
  6. Be Involved in your Child’s CBT Anxiety Treatment: Parental involvement is critical for many reasons including learning about anxiety disorders and their treatment, learning which parenting strategies increase and which decrease child anxiety, learning to coach your child in use of anxiety management skills in challenging moments, not permitting the dance of avoidance, modeling use of skills and brave behavior, learning to tolerate when your child is experiencing distress and responding with empathy and approach, providing many opportunities for exposures and rewarding brave behavior. Parents can also use their understanding of anxiety disorders and their effective treatment to communicate important information with schools, coaches, grandparents and other involved caregivers and settings.

Do You Have An Anxious Child?

No question, hands down, I get more requests from friends, family, and acquaintances for help finding support and and advice parenting anxious children than any other pediatric issue in the school years. So it’s my sincere DELIGHT to introduce and partner with Dr. Kathy Melman on my podcast. Dr Melman runs the outpatient psychiatry and behavioral health clinic and has decades of experience advising families and supporting anxious children. She helps translate the facts around what causes anxiety, how to discern anxious behavior from clinical anxiety, and helps parents understand just what we know and what we don’t. Her tips and advice below!

Where Does Anxiety Come From?

1. Anxiety is a normal emotion and a natural part of life. Fear exists in all of us and there are typical fears that are seen at different developmental stages such as Stranger Anxiety (clinging and crying) at 7-9 months of age. This happens as the child goes through developmental changes such as the stronger ability to differentiate familiar faces from those that are unfamiliar. Anxiety is a normal and important emotion that is adaptive and protective. For example, anxiety helps us stay away from dangerous situations such as leaving or not entering a building when we see smoke or fire or smell something burning. Imagine living at a time or in a place without grocery stores or restaurants for securing food, without homes with locking windows and doors. Imagine that we instead have to venture out to hunt and gather food with concern about dangerous animals or people lurking behind a bush. In this situation, concern about safety is warranted and being vigilant, scanning the environment to pick up on danger cues would help someone survive. The rush of adrenaline that occurs when highly anxious is called the “fight or flight” response and it helps someone escape or avoid dangerous situations.

2. Environmental Stress: Anxiety increases in more stressful situations. This can includes fear of safety, homelessness, instability with frequent moves or other important life changes, loss or death of caregivers or other important people, war, hearing or seeing disturbing news, economic difficulties, abuse, sexual assault, bullying at school, high pressure, expectations and demands in school, home and/or activities. Even in healthy, safe environments, all children experience some anxiety. For example, occasional or short lived worries occur when a child is faced with an especially stressful or new, unfamiliar situation. These are real issues with all that is going on in the world right now.

3. Environmental Learning: Dr. Melman reminds, “Children Learn What Children Live.” Modeling matters. Listen to what Dr. Melman shares in the podcast about overprotection and the risks of being over-involved.

4. Avoidance. Anxiety is maintained and strengthened by avoidance. Through avoidance, you don’t get to see that your worst fears will not happen and that you can, in fact, do it! Let’s look at an example of a child invited for a sleepover at a friend’s house. Perhaps this child is not experienced with sleeping away from home and struggles with sleeping in his own room and bed at home. The idea of a sleepover sounds fun and then reality hits as the time to go to sleep approaches. The child becomes panicked, maybe with physical symptoms such as heart racing and pounding and stomach aches. He has thoughts that he won’t be able to fall asleep or that something bad will happen like a robber breaking in, and calls his parents to pick him up which they do. The child starts to feel relieved and no longer anxious as soon as they learn that they can escape this feared situation by going home. The child’s fear and desire to escape and avoid is strengthened because of the strong relief is experienced when rescued and by the fact that parents agreed that there was a need to come home rather than an ability to cope, ride out this wave of distress, stay the night and see that nothing bad happened and that he could, in fact, be courageous!

5. Expecting Bad Things to Happen: Anxious thinking also plays a role in where anxiety comes from.

6. Genes: Anxiety Disorders runs in families. What can we do if our child has a genetic loading for anxiety disorders? While we can’t change genes, we can aim to reduce stress in our lives and change our own modeling and reactions. We can learn to understand and accept our child’s temperament/wiring and empathize with our child’s feelings while also teaching our children how to think more realistically about the world, to expect less danger in situations, and encourage our child to approach in a gradual and consistent manner the situations that he or she fears. We can give our children skills to cope more effectively with challenging situations.

How To Talk To Boys & Girls About Sex

I haven’t felt like a pro in knowing how to talk about sex with my boys. No matter that I was a middle school science teacher, I’m now a pediatrician and an ever-evolving mom of two. It’s a tough topic even for me as a “talker.” So it was a TRUE JOY and huge relief (let’s be honest) to podcast with two international pros in talking-to-girls-and-boys-in-building-up-esteem-and-confidence-and-knowledge around puberty and sex…

This past month I spoke with Great Conversations co-founders, Julie Metzger and Dr. Rob Lehman. They share their profound expertise and compassion in talking to boys and girls about sex and sexuality and supporting children growing into adults. We broke these podcasts up by age — what to say to a 9-year-old versus what to say to 12 year-olds and what we can say to our teens. I learned so very much from these courageous, kind, and amazingly brave experts — about our connection to the success for our children — and how we meet soul-to-soul with our children in conversations as they traverse life and sex and growing up.

4 Quick Tips For Talking About Sex With Boys and Girls:

Here’s a few takeaways but really, it’s better if you listen to Julie and Rob explain in the podcasts. Really.

  1. “Don’t over speak!” advises Julie Metzger. It only takes 1 minute of courage! Our kids and teens don’t want long-winded, hour-long conversations when questions come up. Keep it short and simple and don’t freak out. Julie teaches girls to plant questions when there isn’t even time for a big response so we adults can get ourselves together to respond. And she reminds: swift, authentic answers when children ask questions are likely best. Phew… one minute of courage. I can do that.
  2. Happenstance helps: Some of the best conversations happen because of what is happening in the world (dogs mating, Janet Jackson’s top falling off, buying tampons and children asking about it). And this is a series of a bazillion conversations throughout a child’s lifetime, not one BIG SEX TALK. Let the nuance and randomness of life support your conversations over time about sex, sexuality, their bodies, and their opportunities.
  3. Everybody wants this to go so well: So many people want puberty and “the sex talk” to go well but even more so, everybody wants a child to do well in their teen years as they grow up. These children are literally flanked by those who want the best for them. From teachers, to parents, to coaches and pediatricians, relatives and neighbors. You have a network of people who want to help and support your child/teen through this time period — remind your teen.
  4. Lead with the positives and avoid conversations that involve “don’t.” You can express your values without closing doors. Opening lines for sharing your beliefs without shutting things down for your child: “What we hope for you is……” or “in our family we believe….” And the other thing — if and when the puberty talk comes up or the sex talk floats in the air, talk about the great things in puberty first (getting taller, gaining independence, more feelings of love and crushes and lust for others) before delving into the tough stuff that may seem a bit unsavory.

Helpful Resources

Infants Turning Blue And Other Scary Things

EVERY new parent worries about their newborn from how much they are eating, sleeping, peeing and pooping to ensuring they hit developmental milestones. We also worry about how they breathe and how they sound. It’s a stressful time period and most aren’t running on tons of sleep themselves — so we’re more emotional baseline. Occasionally, a terrifying thing happens where your infant turns bright red, or even blue or pauses their breathing. They may arch in a funny way or get stiff in their arms or legs. We may wonder if something serious is going on. If your infant (under 12 months of age) has an episode where they have pauses in breathing for less than 1 minute, they turn blue and then recover to normal…chances are…it’s normal. Normal? Turning pale or blue doesn’t seem normal nor does having your baby get stiff, nor does a second where they pause their breathing, but it can be, and there’s a name for it: Brief Resolved Unexplained Event (BRUE).

No question we have to trust our instincts if we think something isn’t going well for our babies and I always suggest seeing your pediatrician or family physician or nurse practitioner if you worry about your infant’s health, for reassurance. No question! Go in, get reassurance and learn. Don’t ever feel bad if everything checks out — this is why your pediatric team is there for you and your family. However, when you do go in for an evaluation from a nurse practitioner or physician,  even if your baby has unusual breathing at times, or tenses, or even has a change in color, you may not need a lot of testing. Sometimes it’s normal.

Some Information About Breathing Patterns In Infants:

  • Periodic Breathing: Newborns breath less regularly than older infants, children or adults. This is in part because of their immature brain stem (the part our brain that regulates the drive to breathe). The majority of newborns experience some periodic breathing in first couple weeks of life and most infants don’t have periodic breathing after 4 or 5 months of age. The term “periodic breathing” captures behaviors where babies breathe rapidly for a few moments, then pause for a few, then breath rapidly again. Most of the time periodic breathing happens with pauses that last no more than 10 seconds. It can appear really unusual to a new parent or relative. The Academy of Pediatrics defines it this way: “Breathing is often irregular and may stop for 5 to 10 seconds—a condition called normal periodic breathing of infancy—then start again with a burst of rapid breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular breathing until the cycle repeats itself. The baby’s skin color does not change with the pauses in breathing and there is no cause for concern.”
  • Color Change: babies can change color with crying, eating, fatigue or movement. Most of the time parents notice that babies will get bright red or ruddy while other times parents worry their baby looks pale or even a bit blue. It’s true that color change can represent underlying heart or breathing problems so if ever sustained over 1-minute it needs to be evaluated promptly. However, color change in infants over 2 months of age that resolves within 1 minutes may not need any work-up after you check in with a clinician. Sometimes color change can come from things like gastroesophageal reflux, coughing or choking, too. If any concern about your baby’s color it’s worth checking in with the pediatrician for a physical exam. While in the office, a pediatrician will do a full physical exam and ask lots of questions, and they can also check a spot oximetry for oxygen levels (pulse oximetry is standardly obtained in first 24 hours after birth to check blood oxygen levels to screen for underlying heart problems), do a electrocardiogram (EKG), and have observation.
  • Noises: babies make all sorts of terrifying sounds! Gagging sounds, choking, gurgling, sneezing, and coughing. Most of these during infancy fall in the range of typical and normal if they don’t interfere with eating, breathing, and sleep. Sneezing is fairly common in the first couple months, again because of immaturity of reflexes. Some parents worry about babies who spit up and sound like they can’t breathe and want to put babies on their tummies. No evidence that is recommended and to lower risk of SIDS, we always recommend babies are put on their back in bare crib for sleep.

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The Penis Podcast

This is a podcast episode about one thing…the penis. Guest on the podcast Dr. Rob Lehman, the co-founder of Great Conversations and leader of the For Boys Only classes at Seattle Children’s hospital joins me to discuss what’s “normal”  and all the examples of “normal but different.” We dive into what parents need to know about care of uncircumcised/circumcised penis, thoughts on erections (they begin in utero!), boys with their hands down their pants, appropriate touching and ways to help boys deal with a culture focus on size. I often say that when I’m in clinic, I get the most attention from parents when I’m talking to them about their child’s genitals and many families are nervous to ask about concerns. It’s something everyone wants to know about, but a lot of people are shy or embarrassed to bring it up — do hope this podcast helps. Don’t hesitate to ask concerns you have from the very beginning — most often you’ll likely get A LOT of reassurance.

I am a mom to two boys and like every other mom I know was surprised from the beginning with the amount of “hands down the pants” moments that start even in infancy. A treat to have Dr. Lehman provides great tips to normalize and set appropriate boundaries for touching and clear up ideas for better understandings of normal development.